Understanding enterprise imaging
Perhaps the biggest trend health information technology today is the movement away from traditional picture archiving and communications systems (PACS) and cardiovascular information systems (CVIS) to enterprise imaging and data management systems. This migration is important, because it will fundamentally change how clinicians have been accessing images and patient information for the past 20 years.
The basic idea of enterprise imaging is to take all data (which includes images, waveforms, reports and other patient data) and amalgamate it into one place, instead of the current system of data residing in numerous, disconnected departmental data silos. With the introduction of vendor neutral archives (VNAs) and cloud-based (or Web-based) digital archives, data from all departments can be put into one pot and accessed using a universal viewer. This enables the data to be managed by the healthcare system’s information technology (IT) staff, rather than individual departments or radiology. Content management software is used to sort the data so it can be pulled out of the system and sent to where it needs to go. Using this model, a patient’s electronic medical record (EMR) can include embedded links to reports and images from all specialty departments in one location by interfacing with the central archive. VNAs also help overcome many of the issues with interoperability between various departments and software vendors’ systems that plague most hospitals.
The buzz term at the 2014 Radiological Society of North America (RSNA) meeting in December was “deconstructing” PACS and CVIS. In this concept, the VNA provides access to the data so the components of PACS and CVIS can be pulled apart. In this manner, a department can pick the best viewers, DICOM worklists and reporting software from various vendors to build what they feel is a best of breed system. This new concept has led some traditional PACS vendors to no longer use the term “PACS” and instead refer to their systems only as “enterprise imaging systems.”
The Need for Enterprise Imaging
Radiology has traditionally been the gatekeeper of imaging, with images residing in a siloed radiology PACS. However, as healthcare becomes more digitized and nearly all specialties now generate images and reports that need to be archived electronically and made accessible via EMRs, the traditional radiology PACS is becoming just one cog in a much larger healthcare machine. Specialties such as cardiology, orthopedics, oncology, women’s health and pathology now generate vast numbers of imaging files on their own, giving rise to specialty PACS. However, the need to connect these multiple, disparate systems into one electronic patient record has proven a major difficulty for all healthcare systems that have attempted it. Despite the advent of IHE (integrating the healthcare enterprise) profiles to make healthcare software for various vendors more compatible, there are just too many variables to ensure the smooth flow of data from point A to point B across an enterprise. VNAs help enable connectivity in a healthcare enterprise, similar to the Internet enabling connectivity between millions of people globally who are using different operating platforms.
The VNA platform also can serve as a disaster recovery system or the backbone of a health information exchange (HIE).
The Role of Healthcare Reform
Healthcare reforms under the Affordable Care Act (ACA) demands all healthcare IT systems interoperate to improve efficiency. The law also calls for leveraging IT to transform healthcare from a volume-based to a quality-based reimbursement system. With the expanded use of EMRs demanded as a component of the ACA, the federal government has established Meaningful Use (MU) criteria that must be met to ensure full Medicare reimbursement for services provided. VNAs allow for the improved level of interoperability MU demands now and into the future.
Stage 2 MU requirements call for remote viewing systems to allow referring physicians or others access a patient’s EMR to view images and reports from various departments. It calls for the integration of patient access to health information and images via patient portals to increase patient engagement. This may play a larger role in the future, as patients with chronic conditions like diabetes and heart failure will be asked to take a more active role in their healthcare with remote monitoring programs. Clinical decision support and computerized physician order entry (CPOE) is now being required to improve patient safety, eliminate illegible written orders, record all orders in one location, reduce redundant tests and to justify use of expensive tests or imaging exams. VNAs also can help enable remote access to patient data using mobile devices, such as tablets by physicians on rounds, anywhere in the hospital, on the road or at home. This may lead to a reduced reliance on workstations in fixed locations, allowing greater workflow efficiency and improved patient communication and education.
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